Adult Participant Waiver, Release of Liability, Assumption of Risk, and Concussion Acknowledgment

Academy: Kick And Roll Academy LLC – Green Forest, Arkansas

Owners/Instructors: Jenson Scarrow and/or Haley Scarrow

Participant’s Full Name:

Age/DOB:

Medical Issues / Allergies / Conditions:

1. Activities and Risks

Kick And Roll Academy offers instruction in Judo, Brazilian Jiu-Jitsu (BJJ), Muay Thai style training, yoga, dance fitness, and related exercises and sparring. These activities include physical contact, movement, stretching, balance work, and fitness exercises and carry risks of injury, including bruises, cuts, sprains, broken bones, strains, falls, concussions, or more serious harm. I understand these risks are part of the training and cannot be fully eliminated.

2. Assumption of Risk

I voluntarily accept all risks of participation, whether known or unknown, and even if caused by the Academy’s negligence or the actions of others.

3. Release of Liability

In exchange for being allowed to participate, I release Kick And Roll Academy LLC, Jenson Scarrow, Haley Scarrow, instructors, staff, and the facility from any claims for injury, damage, or loss related to my participation — to the fullest extent permitted by Arkansas law. This includes claims due to negligence.

4. Indemnification

I agree to cover any costs or legal fees if a claim is made against the Academy because of my participation.

5. Health and Medical Consent

I confirm I am healthy enough to participate and have no undisclosed medical issues. I authorize Academy staff to get emergency medical care if needed, and I agree to pay those costs.

6. Concussion Acknowledgment

I have received and read the Arkansas Concussion and Head Injury Information Sheet. The Academy provides information about concussion risks, prevention, symptoms, and return-to-play steps. If I show any signs of a concussion or head injury, I will stop activity and will not return until cleared in writing by a qualified healthcare provider. I agree to report any symptoms right away and follow the guidelines.

7. Child Safety Practices

I understand that Kick And Roll Academy follows standard safety practices to help keep all participants safe during classes.

8. Photo/Video Permission

I allow the Academy to use photos or videos of me for promotion (website, social media, etc.).

9. Agreement

I have read this waiver, understand it, and agree to its terms. This is governed by Arkansas law.